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| Non Operative Thoracic Duct Embolization for Traumatic Chylothorax: Experience in 103 patients | |||||||||||||||||||
Maxim Itkin, John c. Kucharczuk, Scott O. Trerotola, Andrew Kwak, Constantin Cope, Larry R. Kaiser; Maxim iItkin, University of Pennsylvania, Philadelphia, PA
Methods: A retrospective review of 103 patients (52 male, 51 female, average age 59) was conducted to assess the efficacy of thoracic duct (TD) embolization or interruption for the treatment of high output chyle leak caused by injury to the thoracic duct. Results: Causes of the chyle leak in 103 patients are listed in the Table. 101 patients presented with chylothorax (left 46, right 44, bilateral 11), while one patient had chylopericardium and one had a cervical lymphocele following neck dissection. 17 patients (16%) had previous unsuccessful attempts at thoracic duct ligation. In 102/103 patients lymphangiogram was able to be performed successfully. Catheterization of the TD was achieved in 68 (66%) patients. Catheterization of the duct is dependent on being able to achieve puncture of the cisterna chyli. In 66 of these 68 patients embolization of the TD was performed; in 2 patients it was not attempted. Endovascular coils and/or fibrin glue was used to occlude the TD. In 18 of 35 cases where catheterization of the duct was unsuccessful, TD needle interruption was attempted. Resolution of the chyle leak was observed in 60/66 (91%) patients post embolization (3 failed, 2 were lost to follow-up, and 1 died within several days post- procedure from unrelated causes). Needle interruption of the TD was successful in 13/18 (72%). patients. In 14 of the 17 patients who had previous attempts at TD ligation, embolization or interruption was attempted in 14 and was successful in 11 (78%). The overall success rate for the entire series was 72% (73/103). There were three minor (3%) complications: 1 asymptomatic embolization of glue into the pulmonary artery and 2 patients developed transient lower extremity edema. Conclusion: Catheter embolization or needle interruption of the thoracic duct was safe, feasible and successful in eliminating a high output chyle leak in the majority (72%) of cases. This minimally invasive, though technically challenging, procedure should be the initial approach employed for the treatment of a traumatic chylous. List of the causes of the chylous leaks
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